Quality and Safety in Palliative Care - the view from NHS QIS Dr Frances Elliot Chief Executive 3 December

 Better Health, Better Care (2007)  Better Cancer Care (2008)  Living and Dying Well (2008)  Scottish Government Quality Strategy (2009) Strategic context

 Special Health Board established by the Scottish Parliament in 2003  independent in our advice, assessments and recommendations NHS QIS

Our vision and purpose To deliver internationally recognised excellence in quality improvement

What we do We :  provide advice and guidance on effective clinical practice, including setting standards  drive and support implementation of improvements in quality  assess the performance of the NHS, reporting and publishing the findings  Increasingly we do this as an integrated approach

NHS QIS Key Activity Advice, guidance and standards Implementation and improvement support Assessment, measurement and reporting Local improvement cycles Assurance Accountability

Implementation  Scottish Patient Safety Programme  New Directorate of Improvement and Implementation Support  Networks Clinical Practice development  Clinical governance support  Scottish Patient Safety Programme  New Directorate of Improvement and Implementation Support  Networks Clinical Practice development  Clinical governance support

Changing Role  Healthcare Improvement Scotland - a new body responsible for scrutinising health services, including independent healthcare - retains and emphasises current functions of NHS QIS in relation to quality improvement  Healthcare Improvement Scotland - a new body responsible for scrutinising health services, including independent healthcare - retains and emphasises current functions of NHS QIS in relation to quality improvement

The future  Integrated improvement programmes  Based on a robust analysis of the evidence base  Will include a package of advice and guidance for the service  Integrated improvement programmes  Based on a robust analysis of the evidence base  Will include a package of advice and guidance for the service

The future  “Care bundle” approach with appropriate improvement tools for the service to enable implementation  Support from QIS and partners to make it happen  Key quality indicators to enable local self- assessment and reporting on progress, with proportionate external quality assurance  “Care bundle” approach with appropriate improvement tools for the service to enable implementation  Support from QIS and partners to make it happen  Key quality indicators to enable local self- assessment and reporting on progress, with proportionate external quality assurance

Quality Performance Indicator Development Process Preparatory work (QIS Knowledge Management Team) Consultation (Regional Cancer Networks) Finalisation (NHS QIS, QPI development core group) Publication (NHS QIS) Indicator Development (QPI development group) Scoping (QPI development group, NHS QIS KMT) QPI Development Group Launch Meeting (QPI development group) Cancer Taskforce Ratification of QPI’ (Scottish Cancer Taskforce) Months Preparatory work (QIS Knowledge Management Team) Consultation (Regional Cancer Networks) Finalisation (NHS QIS, QPI development core group) Publication (NHS QIS) Indicator Development (QPI development group) Scoping (QPI development group, NHS QIS KMT) QPI Development Group Launch Meeting (QPI development group) ’ (Scottish Cancer Taskforce) Months Preparatory work (QIS Knowledge Management Team) Consultation (Regional Cancer Networks) Finalisation (NHS QIS, QPI development core group) Publication (NHS QIS) Indicator Development (QPI development group) Scoping (QPI development group, NHS QIS KMT) QPI Development Group Launch Meeting (QPI development group) ’ (Scottish Cancer Taskforce) Months

QPI Development Group Launch Meeting  Agree scope of preparatory work  Define criteria for QPI development  Plan for inaugural meeting  Secretariat?  Agree scope of preparatory work  Define criteria for QPI development  Plan for inaugural meeting  Secretariat?

Preparatory Work (2 months)  NHS QIS Knowledge Management Team  Assess current guidance/evidence (AGREE)  Suggest scope for indicator development  Develop scope of indicators – background and need  NHS QIS Knowledge Management Team  Assess current guidance/evidence (AGREE)  Suggest scope for indicator development  Develop scope of indicators – background and need

Scoping (1 – 2 months)  NHS QIS knowledge management team and QPI development group  Briefing paper  Overview of preparatory work  Summarise key information  Recommendations for draft QPI’s  Filter recommendations using agreed criteria/framework  NHS QIS knowledge management team and QPI development group  Briefing paper  Overview of preparatory work  Summarise key information  Recommendations for draft QPI’s  Filter recommendations using agreed criteria/framework

Indicator Development Group (1-2 months)  Review briefing paper and consider proposed draft QPI’s  Create short list (?10)  Define numerators, denominators and exclusions for each draft QPI  Review briefing paper and consider proposed draft QPI’s  Create short list (?10)  Define numerators, denominators and exclusions for each draft QPI

Draft Indicators Ratified  Draft QPI’s presented to LDW Steering Group for approval prior to wider consultation

Consultation (1 – 3 months)  Consultation via local palliative care networks  Who should we consult with?  For what purpose?  Level of user involvement?  Consultation via local palliative care networks  Who should we consult with?  For what purpose?  Level of user involvement?

Finalisation (2 months)  NHS QIS, QPI Development Group  Collate feedback from consultation  Refine QPI’s including numerators, denominators, exclusions  Final ratification by LDW Steering Group  Publication and dissemination to Boards  NHS QIS, QPI Development Group  Collate feedback from consultation  Refine QPI’s including numerators, denominators, exclusions  Final ratification by LDW Steering Group  Publication and dissemination to Boards

Involvement  LDW Steering Group  Agree proposed QPI development process and final sign off  LDW Steering Group  Agree proposed QPI development process and final sign off

Involvement  Quality Performance Indicators Development Group  Short life group  clinical experts  Review information on topics referred from LDW task groups  Draft QPI’s  Definitions  Quality Performance Indicators Development Group  Short life group  clinical experts  Review information on topics referred from LDW task groups  Draft QPI’s  Definitions

Involvement  NHS QIS  Review of evidence  Prepare briefing paper  Quality assurance, consistency checking, advice on implementation  ISD  Alignment with national datasets  Ensure measurability  Input to definitions  NHS QIS  Review of evidence  Prepare briefing paper  Quality assurance, consistency checking, advice on implementation  ISD  Alignment with national datasets  Ensure measurability  Input to definitions

For Consideration and Discussion  Ownership of the process  Ownership of the final output  How do we “badge”  How do we address clinical issues with little or no evidence  Generation of the evidence base  Generation of research questions  Ownership of the process  Ownership of the final output  How do we “badge”  How do we address clinical issues with little or no evidence  Generation of the evidence base  Generation of research questions